Clinical Trials and Tumor Testing
Because we are a research center as well as a clinical provider, the Pancreas and Biliary Tumor Center offers you clinical trials for pancreatic cancer and provides you with the most innovative treatment options, which may not be available elsewhere. We typically have multiple clinical trials open at a time for patients with pancreatic cancer.
Clinical trials study the safety and efficacy of new treatments or new combinations of treatments. Most of today's standard treatments for cancer are based on earlier clinical trials.
Our specialists are actively involved in research, and apply the latest knowledge to your care. Testing of tumors for genetic changes is available to all of our patients, and this information may be used to make decisions regarding clinical trials and new treatment approaches.
Some clinical trials include only patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not improved. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of treatment. Patients can enter clinical trials before, during, or after starting cancer treatment, depending on the design of the trial.
Treatment for Pancreatic Cancer
The main types of treatment for pancreatic cancer include:
- Surgery
- Chemotherapy
- Radiation therapy
Surgically removing the tumor is the main opportunity to cure a pancreatic tumor that has not spread to involve major blood vessels or to other organs, such as the liver. Therefore, we intently work to make patients on the border of being able to have surgery become candidates through other forms of therapy.
Radiation therapy and/or chemotherapy may be used before or after surgery or instead of surgery if the cancer cannot be entirely removed.
You may find it helpful to think of the stages of pancreatic cancer in these treatment-related terms:
- Resectable: Surgery is the primary treatment, often with chemotherapy and/or radiation before or after surgery.
- Borderline resectable: Chemotherapy and/or radiation (and possibly targeted agents from a clinical trial) are followed by surgery, if possible.
- Unresectable: Chemotherapy and sometimes radiation (and possibly targeted agents from a clinical trial) are used without surgery.
- Metastatic: Chemotherapy (and possibly targeted agents from a clinical trial) is the main treatment.
Gastroenterology
A gastroenterologist is often the first physician you see for the initial diagnosis. We use advanced endoscopic techniques, including evaluation of tumors with endoscopic ultrasound, to conduct biopsies and make a diagnosis. You also will see a gastroenterologist if you develop a complication, such as a blocked bile duct, that should be cleared in order for you to start or continue treatment.
Gastroenterology at our Center includes physicians who manage pancreatic diseases and physicians who perform complex endoscopic procedures to diagnose and manage problems. We also have gastroenterologists who focus on patients who are at high risk for developing pancreatic cancer.
If you have a family history of gastrointestinal cancer, you can meet with our genetic counselors for an in-depth risk assessment, including a detailed family lineage analysis, genetic evaluation using state-of-the-art molecular tests, and tailored cancer screening and prevention recommendations.
Surgery
A vitally important component of treatment for some patients with a pancreatic tumor is surgery. At the Pancreas and Biliary Tumor Center, our pancreatic surgical team consists of experienced, high-volume surgical oncologists who focus primarily on these diseases.
- Our gastrointestinal surgeons specialize in pancreatic cancer.
- Our surgical nurses specialize in gastrointestinal and pancreatic procedures.
Quality is associated with experience: We perform more than 100 pancreatic cancer surgeries per year, including the Whipple procedure (a complex procedure to remove the head of the pancreas, the duodenum, part of the common bile duct, gallbladder, and sometimes part of the stomach). Studies show that high surgical volume directly relates to improved patient outcomes. While postoperative mortality at high-volume pancreatic centers across the country is approximately four percent, high-volume pancreatic surgeons at the Center have postoperative mortality rates at one percent or below, among the lowest rates reported.
Dedicated pancreatic surgeons use a variety of innovative techniques including:
- Minimally invasive and robotic surgeries using laparoscopic techniques.
- Spleen preservation, when possible, for distal pancreatectomy.
- Whipple procedures, including pylorus-preserving procedures, depending upon the tumor.
- Portal vein resection for selected patients.
- Newer surgical procedures to remove larger tumors that were previously considered inoperable.
Medical Oncology and Chemotherapy
Our 20 medical oncologists are national leaders in improving the use of chemotherapy for pancreatic cancer through clinical trials and basic research.
We work with our large multidisciplinary team to direct your care. Because of our close integration with other specialists in our Center, our team offers you their collective expertise when formulating and executing an optimal care plan.
When indicated, our medical oncologists administer chemotherapy, a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Our medical oncologists are highly experienced in optimizing chemotherapy and reducing side effects, and your oncologists use their extensive expertise to determine the most appropriate care plan for you. Our medical oncologists:
- Have experience with the latest therapies and have the expertise to tailor these therapies to each patient for the greatest likelihood of a good outcome. Our team will discuss these options with you and your family to determine the right care plan.
- Address difficult symptoms you may be experiencing, such as jaundice, nausea, weight loss, and emotional distress.
Throughout your treatment, our team of nurses, dietitians, social workers, and other staff will work to minimize side effects of chemotherapy and maximize your quality of life.
Radiation Oncology
Our radiation oncologists are national leaders in the use and study of radiation therapy for pancreatic cancer. You will receive a carefully considered, customized plan to use radiation therapy when it is likely to be most effective.
It is critical that radiation therapy is appropriately sequenced for treatment because the order in which you receive treatments makes a difference. We encourage patients who have been diagnosed elsewhere to see us for a second opinion before starting radiation therapy.
- Radiation therapy uses high-energy x-rays to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the cancer.
- Internal radiation therapy, sometimes used if your cancer affects the biliary tract, uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Radiation therapy may be recommended:
- After surgery and chemotherapy to further decrease the chance of the cancer returning.
- To reduce the tumor prior to surgical resection.
- Prior to surgery to help reduce the tumor so it's operable.
- To help control cancers that cannot be removed surgically.
